Tuesday, January 26, 2010

Before the intervention

I think it has been awhile since I have done a detailed update on Tortuga. It has been 6 months since we changed things around for him and I have been doing a great deal of thinking and reflecting on what we have been doing. A post that was really helpful to me recently was Christine's post about RTCs and when to consider them for our children. I fully agree with her perspective and appreciate her presentation of her thinking about this. It made me realize that in some ways what we had done with Tortuga these past few months was set up an "in-home" RTC.  In our case we have kept away what I would consider "bad" RTC influences (peers who could negatively influence him or give him new (unproductive) strategies) and where he cannot focus on attaching (and wanting to attach) to us. The changes in our home have made it so "it would look like they were at an RTC, minus their family, plus a lot of strangers."  (as Christine said in her post.)

 This structure has worked for him and it has worked for us. Every little thing is routinized and structured. His world is very, very small in terms of things and people. He isn't expected to interact with people he doesn't want to be near, nor does he have to participate in all the family activities and responsibilities that upset and challenge him. Most importantly he isn't subjected to what includes constant transitions, unpredictable stimuli, and multiple distractions that prevent him from doing what he needs to do. We aren't subjected to his unpredictable, volatile, and often violent, outbursts at every turn and especially Pollito and Corazon are not subjected to constant meanness, dirty looks, interruptions and verbal attacks. The rest of the kids are happier and much more relaxed (which helps me too). I have written (here, here, here and here plus here and then here and also here) about the many changes we made in his schedule, routines, and our lives over the past 6 months in order to try to create a better living and growing enviroment for all of us. We have had many bumps and regrouping but overall we have been extremely consistent and unwavering in our attempts to give Tortuga what he needs and not what he wants (or what we want for that matter.)

It has been hard, really hard. We have mourned many of what I call the "what could have beens." That's part of what is so painful for those of us with such traumatized kids--the "what ifs" and "what could have beens." If I let myself walk down that road too much it is downright depressing. I have learned to try not to focus on those fun things they might miss out on and concentrate on those positive things I want them to have and experience as they grow up--independence, self-confidence, self-esteem, love for family, connection to others, empathy, sense of self-worth. It's still hard but it helps me gain and keep perspective.

In making his world very, very small we have been able to more readily identify what factors cause him trouble. This in turn has helped us help him. C. has been away quite a bit with travel but as she got home for about 36 hours this weekend we had a chance to check in and talk about next steps for him and for us because the challenges are still great but we also needed to change things up a little more. After a great deal of talking and a good amount of tears we concluded that we needed to "confront" Tortuga with his progress and his greatest obstacles but we also decided that the whole family needed to be involved in his "treatment" in a somewhat different role. In essence, we staged an "intervention" much like what I imagine those sensationalized reality tv shows are like. I haven't been able to process how I think that went but I am working on writing about it. However, I wanted to make note of the changes we have seen in Tortuga over the past 6 months.

Here is a list of behaviors we no longer see or which have been significantly reduced. He NO longer:
  • rolls his eyes when we talk to him about something he doesn't want to hear
  • sighs loudly or exagerratedly yawns when he is being redirected
  • yells at me
  • makes mean faces (squinty eyes, tensed up face, etc.) when he is told to do or not do something
  • slams his door
  • tears his clothes, sheets, pillow, schoolwork, activity books, etc.
  • breaks pencils, toys, book spines, etc.
  • walks away when we are talking to him and he is mad
  • acts impatient when asked to wait or to listen to something that he doesn't like
  • turns his back on us
  • throws things
  • rages
  • postures and aggressive stance (raising voice, hand, body) toward me and Pollito for no apparent reason
  • sets off the door alarm dozens of times when not supposed to (after bedtime, baby sleeping, etc.)
  • argues back just for the heck of it (ODD behaviors significantly reduced)
  • pretends he forgot to hug back
  • screams that he "hates" us and wants to kill us every time he doesn't get his way
  • show disrespect to his clothes, bed, dresser, toys
  • turning his back/sulking/screaming/walking away after being (quietly) redirected in a public place or threatening to run away in public places
  • refusing to comply with simple directions that never changed (walking behind me in grocery store, mouth hug in car if he said something rude/mean, etc.)
  • shouting "I don't care! I hate this family" whenever he was missing out on something
  • meltdowns when frustrated at doing the simplest task--making his bed, sorting his laundry, putting away clean clothes
  • interrupting his routine to ask a question, get my attention, or tell me something that came into his brain (impulse control issues have been HUGE!)
He has greatly reduced the following behaviors:
  • attitude toward me and C.
  • complaining (which used to lead to rages) when he didn't like consequences of his actions
  • muttering to himself, using weird voices, sneaking notes under Corazon's door, veiled threats to Corazon and Pollito
  • "forgetting" important steps in his routines and then getting angry when redirected
  • gorging himself at every meal
  • meltdowns after outside physical/fun activity (these transitions were an absolute nightmare!)
  • saying "mean" or scary things to Pollito when he thinks others aren't hearing him
He has greatly increased his ability to:
  • accept redirection and even says "thank you, mom" or "thank you for helping me" almost every single time
  • wait patiently for his turn without interrupting
  • ride in the car without talking incessantly and/or inappropriately
  • calm himself before escalating, melting down and/or raging
  • STOP in the middle of doing something/saying something inappropriate and asking to do it over again
  • control his impulses and ask questions at the right time (rather than in the middle of his routine or when the thought pops into his head)
All of these are little things and big things at the same time. Of course, we still have issues--big ones--but this is getting really long so I am going to discuss those in my post about the actual intervention. If your are interested stay tuned...


ldw said...

I am SO happy to hear about the improvement, I know this has been a hard time for all of you. You are an amazing and loving mom even on those times you second guess yourself! I miss you and we must get together soon!

Lisa said...

These are huge things. Yay for progress. It's so important to list all the progress to realize how far our kids have come.

Hugs to all of you!

Lee said...

He has accomplished so much! Is this really just in 6 months????? I am also in awe of the fact that in essence you were able to take the needed RTC structure and put it into your home. That was something I could not figure out how to do and why Fiona could not live with us. I felt somewhat vindicated when a couple of signficant tests led two sets of professional teams to determine she could not be safe in a home environment. Still a big part of me wonders if I could have done what you have with Tortuga if things could have been different.

Christine said...

Today I was outside working (hauling dirt and rocks - fun, fun!). It gave me time to just think. I was also going back over the list of changes.

I need to write them out. Because what you wrote was amazing. Big changes. To put them all together shows healing.


Love you guys.

Mama Drama Times Two said...

Interested? It's like waiting for the next Harry Potter Book. I am truly impressed with the gains you have made - and the connections he is making. The time and emotional investment you both are making now will only enhance his future.

Sammie said...

What a great update. Having two kids myself with many issues, I know how hard it is to put in place this kind of change. You worked hard and your family has benefited, and especially your son.

Thanks for sharing the positive results.


Essie the Accidental Mommy said...

Those are some REALLY LONG lists! Way to go!

BT said...

Dia, this is incredible progress. I hope you and C take a moment and give each other (and yourselves) a pat on the back. Having regressed our P over a week-long period, I cannot imagine the workload you've encountered in shrinking Tortuga's world so much for so long. Great great work! And I am so happy that you're seeing results. He must be starting to feel at least a little better on the inside.

We didn't do anything nearly as intensive with P, but I found that once his improvements/healing started (really started, I mean, after a prolonged escalation following the onset of our intense therapeutic parenting followed by a LOOONNNGGG period of little steps forward, several steps back), things snowballed somewhat. In a positive way. It was as though each additional trust and cooperation was easier for him to allow himself. So they started to come faster and cover more of the spectrum. Not without missteps, relapses, and regressions, of course, and of course we're not done yet (not sure we ever will be), but he has become increasingly more of a pleasure to parent. I hope you will experience this as well.

Please keep the reports coming. They are so helpful for reminders, ideas, and comparisons.

J. said...

I think taking the time to write it all down is a great idea, sometimes we forget how far they really have come. Here's to more growing!

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